British Journal of Renal Medicine - 2015

Comment: Salt to tasteJohn Bradleypp 59-59For many years, the four basic tastes were considered to be sweetness, sourness, bitterness and saltiness. The Japanese have recognised a savoury taste, called umami, for over 100 years, but it was not widely accepted as the fifth basic taste until after the 1st International Symposium on Umami Taste in Hawaii in 1985. Taste buds in the mouth and throat process and integrate these tastes to determine whether they are perceived as pleasant or unpleasant.

Preventing acute kidney injury recurrence: do we warn patients about nephrotoxic medications?James McGuinness, Oliver Lloyd, Jennifer Hind, Sian Finlay and Thalakunte Munirajupp 60-62Acute kidney injury (AKI) is common, serious and expensive, with even small rises in serum creatinine having measurable adverse effects on patient outcomes, including mortality and length of hospital stay. Strikingly, there is evidence that many cases of AKI may be preventable. A 2009 National Confidential Enquiry into Patient Outcome and Death report found that 21% of patients who died of hospital-acquired AKI had both predicable and avoidable risk factors. Stevens et al identified an iatrogenic component in 34% of AKI cases, with 18.4% being preventable. The majority of these cases were due to adverse effects of medication.

Familial hyperaldosteronism: the clinical and genetic pictureGema Souto-Adeva, María M Adeva-Andany, Alberto Domínguez-Montero, Paraskevi Xekouki and Constantine A Stratakispp 63-67Primary aldosteronism is one of the most frequent causes of potentially curable systemic hypertension and can be ameliorated by surgical or pharmacological intervention. Early detection is crucial in order to avoid life threatening cardiovascular events, including stroke, acute coronary syndromes and atrial fibrillation. In addition, primary aldosteronism is associated with abnormal glucose metabolism and may induce maternal and fetal morbidity during pregnancy.

Bookshelf: Clinical Companion in NephrologyDonal J O’Donoghuepp 68-68Mark Findlay and Christopher Isles have written a refreshingly concise primer in renal medicine. It is easy to read and logically organised, and it uses real-world cases to raise and answer clinically relevant questions.

What I tell my patients about interdialytic weight gainElizabeth J Lindley, Claire Gardiner, David Keane and Mark Wrightpp 69-71Although you may sometimes put on ‘real’ weight (that is, flesh weight) between dialysis sessions, especially after a bout of illness, interdialytic weight gain (IDWG) is usually due to the accumulation of fluid. This article is about managing interdialytic fluid gain (IDFG). As long as you do not gain or lose real weight, your IDWG in kilograms will be the same as your IDFG in litres.

Dialysis commissioning: time for the kidney community to seize the initiativeFiona Loudpp 72-72In October 2014, the kidney community was informed by NHS England that it intended to devolve dialysis services to clinical commissioning groups (CCGs). Initially, no consultation was planned and it was intended that the new model be implemented from April 2015. NHS England did not provide a clear explanation for the basis of its proposed changes, nor did it explain the expected improvements or the rationale for implementation within such a short period of time. The approach of devolving res-ponsibility for dialysis to CCGs was inconsistent with the commissioning of kidney transplantation, which would remain a specialised service, despite being part of the same care pathway for people with kidney failure.

Cystinuria: an inherited genetic disorder that breaks the rulesJohn Sayer and Richard Cowardpp 73-75A Kidney Research UK-funded research fellow, Dr Hannah Rhodes, working in a collaboration between Bristol University and Newcastle University, has provided important insights into the complexities of the rare inherited renal stone disease cystinuria. The typical textbook descriptions of this severe condition are often incomplete. The molecular genetics of cystinuria and the clinical phenotypes associated with different forms of the condition have been clarified. Here we report the inheritance patterns and clinical outcomes, including surgical procedures and end-stage renal disease, in a UK cohort of patients with cystinuria.

Powerful PeopleDonal J O’Donoghuepp 77-77For decades, policy-makers have focused on structural and organisational changes as the primary means of driving improvement. Our NHS is still coming to terms with the new architecture introduced by the most recent reorganisation in 2013. Although, to be fair, the quality, productivity and sustainability challenge has been well articulated in The Five Year Forward View. Other levers for change – competition, transparency, incentives – have been deployed with some success. In these austere times, competition has given way to collaboration, and incentives often seem perverse, rather than facilitating the improvement they are designed to achieve. But a key catalyst for change has been missed: patient power.

Ocular complications of anti-glomerular basement membrane diseaseJacqueline Nevols, Nishanthan Srikantha, Kunal K Dansingani and David Farnworthpp 79-81Anti-glomerular basement membrane (anti-GBM) disease is an immune-complex-mediated small-vessel vasculitis predominantly affecting the kidneys and lungs. Anti-GBM disease is rare, with an incidence of 0.5–1 cases per million per year. Autoantibodies are targeted against certain epitopes of type IV collagen, the dominant collagen found in glomerular and alveolar basement membranes. This particular type of collagen is also found in various ocular structures, but case reports of eye disease associated with anti-GBM disease are rare.

The British Journal of Renal Medicine was previously supported by Baxter Healthcare from 2011 to 2013, by Sandoz in 2011, by Shire Pharmaceuticals from 2006 to 2011, by Ortho Biotech and Shire Pharmaceuticals in 2005, by Ortho Biotech from 2000 to 2005 and by Janssen Cilag from 1996 to 2000.

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